family planning/hiv integration in a large pepfar hiv program – the zpct ii experience prisca...
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Family Planning/HIV Integration in a Large PEPFAR HIV Program – the ZPCT II Experience
Prisca Kasonde MD, MMed, MPHDirector Technical Support, ZPCT II/FHI 360
AIDS 2012 - Turning the Tide Together
ZPCT II Background
• Five-year contract funded by PEPFAR through USAID(June 09 – May 14); FHI 360 is the prime partner
• Supports the Ministry of Health to strengthen and expand HIV related services in five provinces
• Objectives include:– Expand and scale up HIV services (CT, PMTCT, ART, MC, Lab & Pharm)– Collaboration with other partners in providing comprehensive HIV
services– Capacity building of MOH– Private-public partnership– Integration at all levels
ZPCT II Coverage
• ZPCT II Supported Districts:– 6 provinces– 370 public + 17 private HF
Rationale for FP/HIV Integration
• High fertility (6.2), high unmet need for FP (27%), high HIV prevalence (14.3%) and high maternal mortality ratio (470/100, 000 live births) in Zambia
• FP is important to PMTCT and reducing the incidence of paediatric HIV
• HIV services provide an opportunity to reach people living with HIV with FP information and services
• Family planning services also provide an opportunity to increase access to HIV CT and other HIV services
Rationale for FP/HIV Integration
• Maximizing the limited HR• Reducing the unmet need for FP is a key objective of the
Zambian national PMTCT guidelines. • Integrated services supported by donors, including PEPFAR
International statements supporting FP and HIV/AIDS linkages
• ICPD program of action (UN 1994) • Family planning and HIV/AIDS in women and children (UNFPA,
WHO 2004) – • Intensifying HIV prevention (UNAIDS 2005)• Declaration of commitment to HIV/AIDS (UNGASS 2006)• Maputo plan of action (African Union 2006) –
The ZPCT II Approach to Integration
• Based on overall systems strengthening• Capacity building of HCWs in government health facilities
– FP module part of PMTCT training; orientation done for CT and ART providers– Additionally, some HCWs trained in FP using full package– FP providers trained as HIV counselors– On site hands-on mentorship
• Support service provision– FP counseling part of routine ANC/PMTCT services with provision of chosen
method if desired – FP counseling part of routine CT and ART services with referrals to on-site FP
provider if method desired– CT corners created within FP service areas and provider-initiated testing and
counseling (PITC) initiated within FP
The ZPCT II Approach to Integration (2)
• Task shifting– Use of lay counselors for HIV CT– Lay counselors also provide group education on FP in ANC and PNC
• Ensuring quality of services– On site hands on mentorship– FP included in QA/QI tools
• Monitoring and evaluation– Routine monitoring of FP related indicators on a monthly basis and tailoring
technical assistance to any gaps identified
• Community mobilization– FP messages are part of community mobilization efforts aimed at raising
awareness of HIV prevention
Impact of FP/HIV Integration in ZPCT II Supported Facilities
• Increase in the number of CT and ART clients referred to FP • Table shows numbers 18 months before and after integration
75 0
2571
329
0
500
1000
1500
2000
2500
3000
CT ART
Clients Referred to FP
Before After
Impact of FP/HIV Integration in ZPCT II Supported Facilities (2)
• Increase in the number FP clients receiving CT services • Table shows numbers 18 months before and after integration
Summary
• ZPCT II highlights the feasibility of using a referral-based model to make FP a routine part of HIV care
• FP/HIV integration possible by incorporating FP into core systems strengthening interventions
• More can be done, including tracking and ensuring that referred clients actually receive desired method
• Task shifting necessary in resource limited settings• Collaboration and leveraging different partner resources
needs to be strengthened
Lessons for Other PEPFAR Programs
• HIV programs can be a platform to provide more holistic, integrated care to women and families affected by HIV
• HIV and FP implementing partners can leverage each other to support integration (e.g. training and commodity supplies)
• Global support for integration = opportunity to accelerate progress toward HIV goals, better maternal and infant health outcomes, and greater realization of women’s rights
Couple receiving FP counseling